RM Checklist Client Version

Transcription

1 1 RM Checklist Client Versin IMPORTANT: Please read the first 2 pages befre entering the sessin with yur physitherapist. Summary: The fllwing checklist is an advanced and cmprehensive decisin making prcess fr slving pain and injury. The purpse f this checklist is t facilitate the mst rapid and cmplete slutin pssible with a thrugh, individual apprach, while minimising the chance f any imprtant factrs being missed. Yur rle is t actively participate in this prcess, t learn the significant factrs that cntribute t yur pain/injury cnditin, and t discver what is required t mst rapidly fix yur cnditin, while als learning hw t prevent recurrence. In a small percentage f cases a Plan B may be the mst apprpriate management, and when this is the case it can typically be indicated within 60 t 150 minutes. i.e. yur RM practitiner either fixes yu r will help t find smene that shuld be able t fix yu. Optimal success requires a ne-step-at-a-time apprach, and ensuring that each step is cmpleted fully befre mving n t the next. The use f this checklist may seem t slw dwn the prcess in reality it actually speeds it up by ensuring that yu are fully infrmed f every step, saving time ver the cming sessins. With the majrity f cnditins, significant results and the answer t what shuld fix my cnditin can be achieved within minutes f assessment and treatment time (RM Diagnsis). Fllwing this full-functin pain-free is typically achieved with a further minutes f treatment (RM Fix). Slutins are best achieved when there is minimal delay between cmpleting all the step f the checklist (i.e. multiple sessins in ne day r n cnsecutive days) The next page is a summary f the Ridgway Methd checklist, please read this nw. Frm page 3 nwards is the detailed, step-by-step Ridgway Methd checklist. Yur physitherapist will take yu thrugh each f the steps. Yu are welcme t read ahead t learn mre abut the prcess. The blded sectins are the mst imprtant t fcus n. The nn-blded sectins include extra infrmatin fr yurself and yur practitiner Versin: May 2017 RidgwayMethd.cm

2 2 The Ridgway Methd Difference WHY Client Interview & Explain the RM Prcess? WHY Assess (and Treat) Anything Blcking Prgress? WHY Whle-bdy Assessment? WHY Trial Treatments? WHY Whle-Bdy Re- Assessment? WHY Mre Treatment & Behaviural Change + Exercise? WHY Imprve Perfrmance & Sustain Full- Functin Pain- Free? Versin: May 2017 RidgwayMethd.cm

3 3 WHY Client Interview & Explain the RM Prcess? Highlighted infrmatin dentes a practical step t be perfrmed 1) Interview & Gd Result What is yur MAIN prblem, which yu wuld be mst satisfied with if yu had fixed first? What is the main functin this prblem limits? Have yu received treatment/physi befre? Hw did yu hear abut us? if by wrd f muth Please thank that persn fr us as we can nly be here with that kind f help d yu mind if I thank them als? Hw is yur general health? D yu have ther illnesses? Take medicatins? Survived cancer? Scans/X-Ray/tests? In yur wn wrds, cnsidering everything yu are ging thrugh, including time and expense, what d yu cnsider is a Gd Result? Fr example it culd be sitting with n pain fr an hur, r running 10km with n pain, r wrking fr a full day with n pain? If I hear yu crrectly yur gd result is and if we culd achieve it will be wrth all f the time and expense f ur help? And if yu can achieve this gd result, hw wuld it make yu feel? What impact wuld it have n yur life? I wuld like t hear mre abut yur histry as we g. I wuld like t get started with prblem slving t achieve yur Gd Result, OR If it s imprtant t yu t explain mre f yur histry nw, then I am here fr yu, and I will start the prblem slving when yu are ready 2) Hw are we ging t help achieve yur gd result? Our understanding f neurscience, plus ur experience tells us that lcal prblems, very ften have remte causes Which is why I am ging t take yu thrugh a prcess that invlves assessing yur whle bdy (muscle/jint/nerve/bne/thughts/feelings etc.), t mst efficiently help yu achieve yur Gd Result, and slve the underlying cause t yur cnditin As I take yu thrugh these steps [see the RM Flwchart] I ll explain what I find and hw this can slve yur cnditin Everyne that ges thrugh these steps is pain-free, full-functin and have their [Gd Result] A small percentage require a plan B, and if this is the case fr yu I can wrk this ut within a few sessins Hw des this sund t yu? What else wuld yu like t achieve befre yu leave the sessin tday? Versin: May 2017 RidgwayMethd.cm

4 4 WHY Assess (and Treat) Anything Blcking Prgress? 3) Explanatin and assessment f Anything Blcking The first step is t test fr any nerve r blcking cnditins as these are the mst imprtant t deal with first Whilst I am perfrming the testing, yu must stp, r tell me t stp, if at any time yur pain increases during the testing Practitiner: assess fr any ptentially cautius cnditins Safety first Examples: Lacking active cntrl Grade 3 ligament/muscle tears DVT Stensis Claudicatin Neurlgical tests Nn-musculskeletal symptms/behaviurs Fractures Assessment f Nerve Dynamic Test in 5 regins Have the client self-test any dysfunctins that are measured with palpating the prximal guarding Take a pht f the befre measure Versin: May 2017 RidgwayMethd.cm

5 5 N/A 4) If blcking cnditins are present, let s treat them, r refer yu n In the case f Neural Dynamic Treatment: Befre we mve nt mre testing t find ut the main underlying cause t yur prblem, we are ging t slve the part f yur cnditin that is being cntributed by this nerve irritatin. Nerves are ne f the mst sensitive structures in the bdy, and we find that if we dn t slve it nw, the future releases that we perfrm n yur bdy either wn t wrk well, r wn t hld fr very lng Warning Releasing nerve gliding can have temprary side effects; nly sme peple suffer these; they are an indicatr f effective treatment, they usually reslve within 24 hurs Fr example: Headache Fatigue Sreness Feeling washed ut An ptin t minimise any side effects is t get smaller imprvements in each sessin Wuld yu like t cntinue aiming fr larger imprvements, r smaller imprvements t minimise the chance f temprary side effects? I will nw perfrm sme releases t yur nerves, and we will test hw much they change. Practitiner: A Standard apprach & Treatment may include Nerve Dynamics Treatment Medical guidelines 2 nd pinin frm a clleague Referral fr investigatins Referral-t/wrk-with a different practitiner (acupuncture/physician/trainer/pdiatrist/chirpractr/stepath/massage etc.) Fllwing treatment re-assess all regins Repeat until all regins have n Nerve dysfunctin n testing In the rare case that the Nerve Dysfunctin is nt imprving, r plateauing, and nt getting t 100% gd functin, in <150 minutes it is a gd indicatin fr referral &/r investigatins. Take a pht f the after measure 5) Blcking cnditins have been successfully treated r cleared e.g. All tests are gd, And yur nerves test well The part f yur cnditin that was cntributed t by that nerve dysfunctin is nw fixed Sme peple ntice significant imprvement in their cnditin immediately frm this Sme peple ntice the significant imprvement after treatment t their main cause (PCF) N/A Versin: May 2017 RidgwayMethd.cm

6 6 WHY Whle-bdy Assessment? 6) Explanatin f Thrugh, Whle-Bdy Assessment All dysfunctins, tightness, stiffness, weakness, instability, etc. have ptential t be part f the cnditin. I m nw ging t test each f these - It is nrmal t find many (20-30) unhappy signs whilst we are testing Nt t wrry as each f these unhappy signs can quickly change when the main cause is fund and treated. One is the primary underlying cause t the cnditin. If I can find that and fix it, we will have yur [Gd Result] I als want yu t tell me nw abut any thughts, feelings that yu have abut yur cnditin that might als cntribute? Fr testing muscles - I will start with scanning yur bdy which can feel a bit like getting padded dwn at the airprt. I want yu t test these fr yurself; using yur fingertips, strum acrss the muscle. Happy muscles at rest are flppy like jelly. Unhappy muscles guard t prtect with knts This is a great muscle, whereas the knt is an indicatr f hw unhappy it is, and hw much it cntributes t a cnditin These dysfunctins, r unhappy structures are the reasn yur brain is creating warning signals f pain. When these dysfunctins are fixed, with happy muscles/jints etc., what d yu think will happen t yur pain then? It disappears and then yur brain n lnger will have the reasn t create pain. If yu want t knw why yu are suffering, it s due t a prtective respnse by the brain 7) Perfrm a Thrugh Assessment, Whle-Bdy Assessment Highlight happy/gd and unhappy/dysfunctins thrughut yur bdy Hw d these test t yu? On a scale e.g. 0-3? Practitiner: Assess as many dysfunctins as pssible, at multiple regins f the bdy - e.g. Functinal limitatins (% r degrees), Range Of Mvement (% r degrees), pattern (% r degrees), jint (0-3), muscle spasm (0-3), muscle activatin/cntrl/strength (0-3), muscle length (0-3); frm the regin invlved and frm all regins; + psychlgical signs (0-3). The mre dysfunctins the better, 12+ is gd. The mre dysfunctins gained at this stage the less the chance f cming back t this step later, and the higher the chance f achieving a very rapid result. Explain/have the client see/test/understand each happy sign plus unhappy signs as it is tested.fr ROM, pattern, functinal tests explain what it shuld lk like when ideal, and hw much there is t imprve t achieve ideal. Versin: May 2017 RidgwayMethd.cm

7 7 WHY Trial Treatments? *8) Treatment Testing prcess + What else wuld yu like t knw? The next step fr slving yur cnditin is t: 1) Test all these prblematic factrs, and find ut is the biggest cause f yur cnditin by getting results; & 2) Use these results t learn hw many sessins it will take t get yu ~100%, Hw satisfied wuld yu be if we can achieve this? Is there anything else I can explain abut yur cnditin while I m ging thrugh this testing prcess? E.g. a) Diagnsis? B) What caused it in the first place? C) Why the pain is where it is? D) Hw lng it will take? E) Rles & respnsibilities? 9) Treatment Testing - Hw will we knw if we are n the right track? I want t help yu get t yur gal f [full functin/gd Result]. T d this we need t chse a test/mvement that will easily shw an imprvement when we re treating t the right spt. It shuld als nt aggravate yur cnditin with lts f repetitins. And if we can t use yur ideal limited mvement, we can chse an alternative test, which may, r may nt be clse t where yur pain is. Which mvement d yu think will be the best t test with? Take a befre pht Practitiner: In the cases where the client desn t knw, then the practitiner guides the test t use with the explanatin f why it is mst relevant. Only cntinue nce the client is happy with the test selected. 10) Which dysfunctins are the wrst? Out f all f these dysfunctins and unhappy structures, which nes d yu think are the wrst? (mst tight, mst stiff, mst rpey etc.). We will treatment-test each f these t see what will make the biggest changes, which nes d yu think wuld be best t test first? *11) Hw des it all fit tgether? When we can get gd imprvement in this test/mvement, and all the ther unhappy structures als imprve a lt, what d yu think will happen t yur [functinal limitatin]? And als, t yur pain? Versin: May 2017 RidgwayMethd.cm

8 8 12) Hw d we treatment-test? + Warnings I need yu t repeat yur test mvement and stp when I say, r if yu experience ANY increase in yur pain/resistance/stretch yu must stp at the very start f this nset. The reasn being that every time yu push thrugh this increase, yu risk flaring up yur cnditin. I may cause tenderness t tuch, this is different t yur pain, please put up with this t a tlerable level, as it is temprary, and let me knw if it starts t becme intlerable. Yu may have t be patient as it can take many repetitins t test all the pssible factrs that might be causing yur cnditin. Hw des this sund t yu? Smetimes these results can be s dramatic that we suffer temprary reactins such as dizziness, sweating, feeling faint, and pale. I can g mre gently t minimise these reactins, r I can get the fastest results, which wuld yu like? Sme peple suffer treatment sreness, like a bruise-ache where I d the releases, this is an indicatr f releasing the imprtant structures r again, I can g gentler with smaller gains t minimise the chance f this, which wuld yu like? 13) Let s start treatment-testing and measure if there is change! We re ging t start the treatment-testing (TDTs) Yur jb is t als see what changes might ccur t yur mvement while I d the testing. After each treatment test - Hw different des this lk/test t yu? What did yu see change? By hw much? Practitiner: TDT all treatable dysfunctins ne at a time lking fr either 1) dramatic imprvement, r 2) n dramatic imprvement. If sme imprvement ccurs, repeat trials with different directins/frce f interventin until the biggest imprvement is achieved and plateaus. Stp the interventin and mvement-test fr new baseline. Recrd the percentage change as a prprtin f imprvement (reductin f deficit). Lk back and see which imprvement rates the highest (if multiple interventin imprved similarly then narrw it dwn t the best ne) - find agreement with the client n the interventin/sign that achieved the mst dramatic result. If n significant changes ccur cnsider: 1. Mre thrugh assessment fr missed signs 2. Recheck NDT/cautius cnditins t ensure nthing was missed 3. Bx 11 Standard apprach Versin: May 2017 RidgwayMethd.cm

9 9 WHY Whle-Bdy Re- Assessment? 14) Thrugh, Whle-bdy re-assessment What has changed? The next step is t perfrm a thrugh re-assessment t see which ther dysfunctins have als imprved. This is a summary f all the tests that have imprved significantly. Take an after pht Practitiner: Re-assess all asterisk signs/dysfunctins Recrd which nes have imprved t a similar degree t the mvement-test. Ensure the client knws these signs and understands the cnnectin t their presenting prblem. The interventin that achieves the mst significant imprvement t all the ther signs/dysfunctins that link t that cnditin. 15) Label the prvisinal Primary Cntributing Factr (PCF) Since all these dysfunctins imprved, what d yu think that this indicates? This demnstrates that this structure is the cause t yur cnditin, it is called a PCF. Treating a PCF makes all relevant signs imprve & aggravating this PCF will make all relevant signs wrse. When all yur signs are % better yu will be back t ding _[functinal limitatin]. What d yu think yur hmewrk is ging t be? Yes, t nt aggravate the PCF. Yur hmewrk is t lk after yur PCF by changing habits, ding psture-wrk/exercises, [new mtr cntrl with functin]. It is ideal fr yu t have a specific test, fr yu t mnitr and self-test s that yu can see prgress, which test d yu think will be best fr yu? Versin: May 2017 RidgwayMethd.cm

10 10 WHY Mre Treatment & Behaviural Change + Exercise? *16) Estimate future treatment using the Prgress Graph Mark n the graph hw much ttal strain/dysfunctins remain by judging frm the tests we measured If we get that much each sessin, and yu lk after yur PCF well in between sessins, hw many sessins will it take t get yu ~100%? This is the RM Diagnsis phase Next is the RM Fix phase After yu are 100% are RM tune-ups What might happen alng the way? Re-aggravatin? Time-delay between sessins? At any time we are nt ging t plan we will stp and discuss a new plan What might happen in the future? Cmpetitin? Big wrk days? What might happen after yu are 100%? Just like getting yur teeth cleaned and checked, we d RM Tune-ups Fr sme peple their symptms decrease prprtinately with the graph, fr thers symptms dn t significantly change until under the threshld line. Which is the case fr yu? I want t help yu get better as quickly and efficiently as pssible Hw much d yu want t cmplete this prcess? Hw sn? Is there anything that might prevent yu frm fllwing thrugh with this plan? Versin: May 2017 RidgwayMethd.cm

11 11 17) Let s treat the PCF until ~100% fixed r plateaus Next step is t cntinue treatment and gain mre imprvement, hw des that sund? Practitiner: Chse 3-4 main-indicatr asterisk signs at the beginning f every sessin t establish the new baseline, then frequently, fr example every few minutes, weaned ut t every 5-10 minutes (f treatment) t ensure best interventin is being applied. If plateau f results ccurs, use treatment prgressins When clse t 100% r plateaued re-assess all signs t cnfirm prgress fr the whle cnditin. Invlve the client (palpate/see the results) Let s test t see hw many f yur signs have changed, and by hw much. *18) If we haven t already - Let s teach yu hw t maintain yur imprved PCF - thrugh exercises/hmewrk Pick ne, r tw, specific pstural strategies that the client can apply t maintain/imprve their PCF during their daily life between sessins Manually facilitate the imprved psitin/cntrl fr the client & ask, Hw des this new psitin feel t yu? What wrd/feeling wuld yu use t describe this psitin/exercise? Recrd that wrd as the client s cue fr their hmewrk. Ideally, yu will practice this abut 2000x t get it mstly autmatic, as an exercise, and during functin fr example, 50 per day ttal, fr 6 weeks. When during yur day, and fr hw many reps, can yu cmmit t practicing this? Sitting Standing Walking/Running Sprt/Functin Specific:.. 19) Let s test if there are any stubbrn signs (Secndary Cntributing Factrs) left ver that need treating This mre stubbrn sign may be frm lng term persistence. Treatment directly t this sign might help reslve the last f it. Versin: May 2017 RidgwayMethd.cm

12 12 WHY Imprve Perfrmance & Sustain Full- Functin Pain- Free? *20) Let s discuss keeping yur cnditin in great shape, fr the lng term T keep this cnditin slved fr the lng-term yu need t lk after yur PCF indefinitely, I can ffer check-ups/treatments f accumulating aggravatin; like yu wuld fr yur teeth with a dentist. As a general rule the mre yu lk after yur PCF, the less frequently yu will need t see me. Hw much d yu really want t prevent this cnditin recurring? We are at the stage f weaning ut t RM Tune-ups, hw lng are yu willing t test yurself t see if yu can keep yur PCF at the same level it is at nw? Alternative Plan *21) Let s discuss sme alternative appraches as yur results aren t as expected Practitiner: Be ready and pen fr the small percentage f cnditins that dn t respnd, r respnd incnsistently. These are indicatrs t cnsider all Plan B ptins f: 1. Assistance frm a clleague, 2. Referral n t anther practitiner, 3. Investigatins, etc. Versin: May 2017 RidgwayMethd.cm